Das Kshaunish, Singh Paramjeet, Chawla Yogesh, Duseja Ajay, Dhiman Radha Krishan, Suri Sudha
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Dig Dis Sci. 2008 Oct;53(10):2793-8. doi: 10.1007/s10620-008-0383-y. Epub 2008 Aug 8.
Hyperintense signals in the basal ganglia, namely the globus pallidus, have been reported on magnetic resonance imaging (MRI) in 70-100% of patients with cirrhosis of the liver. Deposition of paramagnetic substances, particularly manganese (Mn), has been reported to be responsible for these hyperintense signals. They are found in cirrhotics with or without overt/subclinical hepatic encephalopathy. Deposition of Mn has been attributed to hepatocellular failure and/or portosystemic shunting. Reports of MRI brain findings in patients with extra hepatic portal venous obstruction (EHPVO) and non-cirrhotic portal fibrosis (NCPF) are scanty in the literature.
The purpose was to determine the basal ganglia changes on MRI in patients with EHPVO and NCPF and to compare it with patients with cirrhosis of the liver.
A total of 27 patients (EHPVO = 10, mean age 28.4 +/- 19.0 years, NCPF = 7, mean age 37.1 +/- 10.4 years, cirrhosis = 10, mean age 47.0 +/- 19.6 years) was studied prospectively from January to December 2001. MRI of the brain was done with a standard spin echo axial T1- and fast spin echo T2-weighted scan obtained on a 1.5-T MRI unit. Two radiologists in a blinded fashion graded the signal intensity of basal ganglia on T1-weighted (T1 W) sequences by comparing it with the adjacent unaffected grey matter.
None of the patients with EHPVO or NCPF had any past history of hepatic decompensation and/or overt encephalopathy. Seven (70%) of the cirrhotics had a past history of overt encephalopathy. None of the patients with EHPVO showed any hyperintensity of basal ganglia on T1-weighted MRI images. Hyperintense globus pallidus was seen in four (57%) and eight (80%) patients with NCPF and cirrhosis, respectively.
Hyperintense globus pallidus on MRI is common in patients liver cirrhosis and also occurs in patients with NCPF. Patients with EHPVO do not have hyperintense globus pallidus on T1-weighted MRI images.
据报道，在70%-100%的肝硬化患者的磁共振成像（MRI）中，基底神经节（即苍白球）出现高信号。据报道，顺磁性物质尤其是锰（Mn）的沉积是这些高信号的原因。在有或没有明显/亚临床肝性脑病的肝硬化患者中均可发现这些信号。锰的沉积归因于肝细胞功能衰竭和/或门体分流。肝外门静脉阻塞（EHPVO）和非肝硬化性门静脉纤维化（NCPF）患者的MRI脑部检查结果在文献中报道较少。
本研究旨在确定EHPVO和NCPF患者MRI上基底神经节的变化，并与肝硬化患者进行比较。
2001年1月至12月对27例患者进行前瞻性研究（EHPVO患者10例，平均年龄28.4±19.0岁；NCPF患者7例，平均年龄37.1±10.4岁；肝硬化患者10例，平均年龄47.0±19.6岁）。使用1.5-T MRI设备进行标准自旋回波轴位T1加权和快速自旋回波T2加权脑部MRI扫描。两名放射科医生在不知情的情况下，通过将基底神经节在T1加权（T1W）序列上的信号强度与相邻未受影响的灰质进行比较来分级。
EHPVO或NCPF患者均无肝失代偿和/或明显脑病的既往史。70%的肝硬化患者有明显脑病的既往史。在T1加权MRI图像上，EHPVO患者均未显示基底神经节有任何高信号。分别在57%（4例）和80%（8例）的NCPF和肝硬化患者中发现苍白球高信号。
MRI上苍白球高信号在肝硬化患者中常见，在NCPF患者中也有发生。EHPVO患者在T1加权MRI图像上没有苍白球高信号。
